手术治疗跟骨关节内骨折

Surgical treatment for intra articular calcaneal fractures

目的:总结手术治疗跟骨关节内骨折的疗效。方法:自2004年9月至2009年10月采用手术治疗跟骨关节内骨折72例,男61例,女11例;年龄19～54岁,平均39.7岁;病程1～17d,平均9.7d。术前术后行X线片和CT检查。根据Sanders分型:Ⅲ型40例,Ⅳ型32例,均采用外侧切口切开复位跟骨解剖型钢板内固定手术方法,取自体髂骨植骨填充骨缺损。根据美国足踝外科协会跟骨骨折的评分标准进行评价。结果:72例均获随访,时间10～48个月,平均38个月。按美国足踝外科协会跟骨骨折的评分标准:优14例,良38例,中9例,差11例。切口不愈合5例,距下关节炎3例。结论:切开复位钢板内固定可以使距下后关节面得到良好复位,是治疗复杂跟骨关节内骨折的有效手段。

Objective：To evaluate clinical result of surgical treatment for intra articular calcaneal fractures using calcaneal anatomy plate. Methods：From September 2004 to October 2009,72 patients with intra articular calcaneal fractures were reviewed. There were 61 males and 11 females,ranging in age from 19 to 54 years old,with an average of 39.7 years old. The course of the disease ranged from 1 to 17 days. All the patients performed X-ray and semi coronal CT scan before and after operation. According to Sanders classification system,there were 40 cases of type Ⅲ and 32 cases of type Ⅳ. All the patients were treated with lateral L-type incision and calcaneal anatomy plate. The therapeutic effects were evaluated according to the standard of calcaneal fracture of the American surgery association of foot and ankle. Results：All the patients were followed up, and the duration ranged from 10 to 48 months,with a mean of 38 months. According to standard of calcaneal fracture of the American surgery association of foot and ankle,14 patients got an excellent result,38 good,9 fair and 11 poor. Five patients got incision non union. Arthritis of subtalar joint was found in 3 cases. Conclusion：Open reduction and internal fixation of plate is effective to get good reduction for subtalar joint,which is a good method to treat intra-articular calcaneal fracture.